214200172-4-22-2022-05-CC-HLEG-CDQVP6-20220422163613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214200172
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:36:26 PM

Document Has Been Signed on 04/22/2022 04:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SANGSTER, DERINDA		FACILITY NUMBER:	214200172
ADMINISTRATOR:	SANGSTER, DERINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 305-0511
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	14	CENSUS: 6	DATE:	04/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Derinda Sangster		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 22, 2022, Licensing Program Analysts (LPA), Leong, conducted an unannounced annual inspection with Derinda Sangster. LPA explained to the licensee about the purpose of the visit. During today's inspection, six children were in the care of the licensee and one staff member. All adult residents at the home have fingerprint clearance on file. The daycare operates from 7:45 am-5:00 pm, Monday through Friday. The daycare areas include the backyard patio, playroom, and bathroom #1. The off-limit areas include the kitchen (pass through only), dining room (pass through only), Hallway (pass through only), bedroom #1 (pass through only), bedroom #2, bedroom #3, bathroom #2 and entire downstairs area. All off-limit areas are properly barricaded. When a child exhibits symptom of illness, the Licensee will separate the child while contacting the parent to arrange for the child's pick-up LPA and the Licensee conducted an inspection of the daycare areas to look for potential health and safety hazards. The daycare is outfitted with age-appropriate toys and equipment. The home is well-lit, well ventilated, and free of defects or conditions that endanger children in care. The daycare is equipped with a smoke detector, carbon monoxide detector, and two fully charged fire extinguisher. All the electrical outlets and trash cans are covered. *See Page 2 for continuation*

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/22/2022 04:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANGSTER, DERINDA	FACILITY NUMBER: 214200172
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not not maintain CPR certification, which poses a health and safety risk to the children. The folllowing safety health and safety code was violated. 1596.866(b) Personnel Requirements
	POC Due Date: 05/22/2022
	Plan of Correction
1 2 3 4	Licensee will take a class in the near future and will submit a copy to the department.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANGSTER, DERINDA	FACILITY NUMBER: 214200172
	VISIT DATE: 04/22/2022

NARRATIVE

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Children have access to first aid supplies. Cleaning compounds, detergents, and other items that could endanger children are kept out of reach of children. Playpens, which include mattresses are available for infants to use for napping. Resting mats are available for other children to use for napping. LPA saw no walkers, bouncers, or other similar items. The backyard is fenced, clean, and equipped with age-appropriate outdoor equipment. According to the Licensee, there are no firearms or weapons on the premises. LPA observed that there were no pools, spas, or other bodies of water in the home.

LPA observed that the Licensee had posted all the required forms, including the facility License, Notification of Parental Rights, Earthquake Preparedness Checklist, and Notification of Personal Rights. The licensee is aware that smoking is not permitted in family childcare homes.

During the inspection, LPA went over all the children's records. Each child has an emergency information card in their file that includes their full name, phone number, and the location of a parent or other responsible adult who can be contacted in an emergency. Each child's file contained parental authorization for the Licensee or registrant to consent to emergency medical care, as well as the child's physician's name and phone number.

***See Page 3 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANGSTER, DERINDA	FACILITY NUMBER: 214200172
	VISIT DATE: 04/22/2022

NARRATIVE

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Every six months, fire and earthquake drills are held and documented.

LPA reviewed all staff records. Both licensee and one staff member did not maintain a current Pediatric First Aid and CPR certification. LPA reminded the licensee that one of her staff members will need to submit immunization records to the department. Additionally, LPA met with the Licensee to discuss supervision and capacity expectations/requirements. Although the Licensee does not transport children, she is aware that children should never be left in vehicles unattended.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPAs discussed the safe sleep regulations with the Licensee and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

*** See Page 4 for continuation***

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SANGSTER, DERINDA	FACILITY NUMBER: 214200172
	VISIT DATE: 04/22/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The Licensee was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPAs reviewed AB 1207 with the Licensee. As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

The following deficiency was issued to the licensee, with a plan of correction.
1. Expired CPR/First Aid Certificate.

Both Notice of Site Visit document and Annual Inspection Report was given to the licensee

A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Derinda Sangster

SUPERVISOR'S NAME: Daniel J Oquendo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Hanson Leong	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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